Tumour necrosis factor inhibitors
What are anti-tumour necrosis alpha drugs?
Tumour necrosis factor (TNF) is a cytokine associated with inflammatory disorders of the skin, joints and gastrointestinal tract.
The most active anti-TNF drugs are monoclonal antibodies targeted against TNF-alpha (TNFα). Anti-TNFα drugs control inflammation in inflammatory skin diseases, arthritis, and bowel disease. They were among the first biologic agents on the market.
Anti-TNFα monoclonal antibodies include:
- Infliximab
- Adalimumab
- Etanercept
- Golimumab
- Certolizumab
Other anti-TNF drugs
Other drugs with activity against TNF include:
- Thalidomide
- Sulfasalazine
- Pentoxifylline
- Buproprion
Natural compounds acting against TNF include:
- Catechins
- Curcumin
- Cannabis
- Echinacea purpurea
What skin conditions are anti-TNFs used for?
The anti-TNF monoclonal antibodies are used mainly in the treatment of severe chronic plaque psoriasis. They are also used for other severe inflammatory skin diseases when conventional therapies have failed. Examples include:
- Hidradenitis suppurativa
- Skin disease associated with Crohn disease
- Pyoderma gangrenosum and PAPA syndrome (off-label)
Skin conditions treated with tumour necrosis factor inhibitors
What are risks of anti-TNF drugs?
Anti-TNF biologics are given by injection. They can sometimes cause injection site reactions or infusion reactions. They should be avoided in patients with severe heart failure.
The main risk of anti-TNF therapy is reduced immunity to bacterial, fungal, viral and parasitic infections, including:
They may also increase the risks of skin cancers and autoimmune diseases, including demyelinating conditions.
Anti-TNFs can lose their effect over time, possibly because of the induction of antibodies against them. Paradoxically, anti-TNFs can sometimes result in dermatological side effects, such as:
- Palmoplantar pustulosis
- Various forms of psoriasis
- Eczema
- Lupus erythematosus
- Morphoea
- Alopecia areata
- Vitiligo
- Granuloma annulare
- Sarcoidosis
- Erythema multiforme
- Vasculitis
- Stevens Johnson syndrome — toxic epidermal necrolysis
- Drug-induced nummular dermatitis
